INFANT & YOUNG CHILD FEEDING IN THE CONTEXT OF COVID-19

Brief No. 2 (v1)

(March 30th, 2020)

To support implementers on how to prepare and respond to the COVID-19 pandemic, a series of evidence-
informed guidance briefs will be produced and updated every ten (10) days as new information and evidence
emerges. This Brief is meant to provide information specific to infant and young child feeding (IYCF) in the
context of COVID-19. This Brief does not cover wider mitigation and response measures available in other
guidance. As a nutrition community, we will continue to develop our understanding on practical solutions to
deliver programming in the context of COVID-19. Documenting and disseminating these lessons and emerging
evidence will be key to implementing the most appropriate and effective responses in the face of this pandemic.

This brief consolidates recommendations on Infant and Young Child Feeding in the context of the COVID-19
pandemic. The recommendations align with WHO’s interim guidance on Home Care for Patients with COVID-
19 presenting with mild symptoms and management of contacts (17 March 2020), the Clinical Management
of severe acute respiratory infection (SARI) when COVID-19 disease is suspected (13 March 2020) and
Operational guidance on infant feeding in emergencies (2017).

KEY MESSAGES AND PRIORITIES

1. Programmes and services to protect, promote and support optimal breastfeeding (early and exclusive)
and age-appropriate and safe complementary foods and feeding practices should remain a critical
component of the programming and response for young children in the context of COVID-19.

2. Mothers with suspected or confirmed COVID-19 and isolated at home should be advised to continue
recommended feeding practicesi with necessary hygiene precautions during feeding.

3. Alignment and coordination in the mitigation plans across nutrition, health, food security and
livelihood, agriculture, WASH, social protection and mental health and psychosocial support to focus
on reaching infants and young children in the context of COVID-19.

4. Actions through relevant systems (Food, Health, WASH, and Social Protection) should prioritize the
delivery of preventive services to mitigate the impact of the pandemic on young children’s diets and
wellbeing with strong linkages to early detection and treatment of child wasting.

5. Full adherence to the International Code of Marketing of Breast-milk Substitutes and subsequent WHA
resolutions (including WHA 69.9 and the associated WHO Guidance on ending the inappropriate
promotion of foods for infants and young children) in all contexts in line with the recommendations of
IFE Operational Guidance.

6. Donations, marketing and promotions of unhealthy foods - high in saturated fats, free sugar and/or
salt - should not be sought or accepted.

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PROTECTION, PROMOTION AND SUPPORT TO INFANT AND YOUNG CHILD FEEDING AT HOME

While this varies by the context and is evolving rapidly, the current recommendation in the context of COVID-19
is that individuals suspected or with confirmed mild symptoms be managed at homeii. Caring for infants and
mothers at home therefore requires practicing WHO-recommended infection prevention and control
measuresiii. In the context of limited availability and compromised access to markets, health facilities or in the
case of lockdowns, communities and households will require information and support on feeding their infants
and young children. Intensifying the protection, promotion and support to adequate infant and young child
feeding is therefore a critical action which needs to consider the context specific barriers and bottlenecks in the
country. Below are key recommendations and considerations based on the global guidance and learning so far:

Recommendation Key considerations

Regardless of the feeding mode:
• Mothers should always wash hands with soap and water at
critical times, including before and after contact with the infant.
• Routinely clean the surfaces around the home that the mother
has been in contact with, using soap and water.
• If the mother has respiratory symptoms, use of a face mask
when feeding or caring for the infant is recommended, if
available. Locally available / adaptive face mask can be used as
an alternative.
• Mother with her infant should maintain physical distancing
Mothers with suspected or confirmed
from other people (at least 1 m) and avoid touching eyes, nose
COVID-19 and isolated at home should
and mouth.
be advised to follow necessary
respiratory hygiene during feedingiv.
Breastfeeding mothersv
• Mothers should be counselled/advised to continue
breastfeeding should the infant or young child become sick
with suspected, probable, or confirmed COVID-19 or any other
illness.

Artificial feeding
• Mothers should be counselled/advised to feed the infant or
young child with a cup and wash hands with soap and water
before handling cups, bottles, teats etc. and limit the number of
caregivers feeding the infant.
• With the potential for limited availability of and access to
nutritious food choices at household level, coupled with
increased demands on parents due to lockdowns, caregivers
Intensify support to families on what,
could feel overwhelmed with childcare and feeding
when and how to feed young children
responsibilities. Provision of specific guidance on age
at home during the complementary
appropriate and safe complementary foods and feeding
feeding period using practical
practices, using digital, broadcast and social media platforms,
communication platforms to reach
will support parental decision making.
families in the context of COVID-19vi.
• Caregivers should be counselled/advised/receive practical,
feasible and context specific information on the importance of
healthy diets and solutions to enable families in maintaining a
healthy diet together with intake of safe and palatable drinking
water for their young children.
2

Intensify promotion of safe hygiene
behaviours especially hand washing
with soap at all critical times and
practicing safe food preparation/
handling to reduce risk of transmission
of COVID-19.
Make simple, practical and context-
specific information available using all
available communication channels
(digital, broadcast and social media) to
the families on healthy feeding
options for young children in the
context of lockdowns and financial
barriers.
•If access to fresh produce is difficult, identify healthy food
options to replace fresh producevii, limit highly processed foods
that are of low nutritional value being typically high in saturated
fat, free sugars and salt, and avoid sugary drinks and follow-on
milks. It is important for young children to consume sufficient
fruits and vegetables, wholegrains and protein sources. These
types of food can be cooked from fresh, dried, tinned or frozen.
• Such information will need to be adapted to address specific
barriers as per the prevailing COVID-19 response within a
country.
• Before preparing or eating food, caregivers should ensure they
practice the recommended hygiene behaviours such as
handwashing with soap and regular cleaning and disinfecting of
food preparation areasviii.
• Ensure integration of targeted context-specific feasible/doable
messages on safe hygiene into all relevant opportunities and
harmonized across multiple communication channels to ensure
its reach and application.
• In communities where eating at a common bowl or feeding
children by hand is common, it is preferable to use the child’s
own plate and spoon to avoid transmission.ix
• Explore innovative ways to deliver services to support the
communities and families such as mobile technology, social
media, radios, cellphones messages, community
announcements, posting information on essential outlets open
for sale (e.g. supermarkets, food shops) TV etc.
• Leverage social media, web and mass media platforms to
provide needed information, clarify misinformation and
misconceptions and support families by providing practical,
feasible and context specific solutions for young children in the
context of limited access to fresh fruits and vegetables.
• Existing resources like radio memes, animations and videos, such
as UNICEF’s first foods video series can be downloaded on
mobile phones to counsel caregivers on what, when and how to
feed their childx. Videos to support breastfeeding (including hand
expression of milk) have also been developed by Global Health
Media and are available on their websitexi.

DELIVERING INFANT AND YOUNG CHILD FEEDING SERVICES THROUGH VARIOUS DELIVERY PLATFORMS

With disruption in routine service delivery through facilities and community outreach during the time of
lockdown, there is a need to find innovative and practical ways to deliver essential services through the Food,
Health, WASH and Social Protection systems to support communities and families in maintaining adequate
diets and the wellbeing of infant and young children. Below are some recommendations and key
considerations for delivery of infant and young child feeding services through multiple delivery systems and
platforms:

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 Recommendation
Support Governments to strengthen the enabling environment to support delivery of services for infant and
young children across the food, health, WASH and social protection systems
Ensure alignment and coordination in
the mitigation plans across nutrition,
health, food security and livelihood,
agriculture, WASH, social protection
and mental health and psychosocial
support to focus on reaching infants
and young children in the context of
COVID-19.
Ensure alignment with the
International Code of Marketing of
Breast-milk Substitutes and
subsequent relevant WHA resolutions
(including 69.9).
Donations of breastmilk substitutes
(BMS), complementary foods and
feeding equipment should not be
sought or accepted by the
Government and partners.
Actions through Food, Health, WASH and Social Protection systems should prioritize the delivery of
preventive services to mitigate the impact of the pandemic on young children’s diets and wellbeing with
strong linkages to early detection and treatment of child wasting
Delivering through the Food System in the context of COVID-19
Ensure the availability of fresh foods
and essential staples for children,
women and families by maintaining
access to local markets, shops and
stores (both physical and online
groceries).
Key considerations
• Ensure alignment and coordination in the review and
implementation of mitigation plans of relevant sectors to
support focus on reaching the most vulnerable in the context of
COVID-19.
• Align the preparedness and contingency plans of nutrition, food
security and livelihoods, agriculture, WASH, social protection
and mental health and psychosocial support sector/clusters on
short term-medium- and long-term actions to support families
in feeding infants and young children a nutritious, healthy and
safe diet in the context of COVID-19.
• Monitor for Code violations and report them to national
authorities, the nutrition cluster/sector coordination
mechanism, and international monitors.
• Support government to develop policies and procedures to
monitor for and act on Code violations in accordance with the
WHO/ UNICEF NetCode toolkit. Typical Code violations relate to
infant formula labelling, supply management, and donations.
• It is Important to raise awareness of health workers on their
obligations under the Code (BMS companies may take
advantage of this situation to try and promote their products
through the health care system), together with disseminating
information on the Code and mechanisms to report non-
compliance.
• Mothers need to be re-assured that it is safe to breastfeed their
children
• Donations of BMS by manufacturers has been shown to lead to
increased use of substitutes and a reduction in breastfeeding.
For this reason, the World Health Assembly (WHA) has stated
that there should be no donations of free or subsidized supplies
of breastmilk substitutes in any part of the health care system.
This prohibition extends to emergency settings where
governments have been urged by WHA to ensure that any
required breast-milk substitutes are purchased, distributed and
used according to strict criteria. For more details refer to
Operational Guidance on Infant Feeding in Emergencies xii
• Ensuring that the local markets, shops and stores remain open
and deliver fresh foods for children, women and families. These
markets/shops/stores should follow recommended hygiene
practices including cleaning of surfaces and products (through
making sanitary wipes/hand sanitizers) and enforcing that the
customers maintain physical distance of at least 1 meter.
4

Provide guidance to the community
and families on healthy food purchase
in the context of Covid-19.
Control the marketing, promotion or
mass distribution of unhealthy foods-
high in saturated fats, free sugar
and/or salt - for children.
Donations of unhealthy foods - high in
saturated fats, free sugar and/or salt -
should not be sought or accepted by
the Government and partners. xiii
Engagement with companies that
produce ‘unhealthy foods’ should be
avoided for financial or in-kind
contributions. Cause-related
marketing and joint communications
should also be avoided.
• Families should be encouraged to prioritize purchase of fresh
and healthy food options (as explained above) for young
children.
• Encourage retailers to ensure that fresh fruits and vegetables are
positioned prominently and sold at reasonable prices.
• The poorest communities will likely be the most affected by food
systems disruptions and income shocks and need support to eat
healthily. If nutritious food is higher priced, then uncertainty may
result in increased purchase of nonperishables, including highly
processed foods high in saturated fats, free sugar, and/or salt
with long shelf life. Particular attention should be paid to
ensuring continuity of supply for nutritious, fresh foods at
affordable prices for these communities.
• Provide families with recommendation on types of food to
prioritise, as well as tips on food preparation at home (could
link to the news story when published?)
• Remind families that highly processed packaged foods are
often less healthy, and contain high amounts of saturated fats,
free sugars and/or salt. Provide guidance to families on how to
read the labels – including the front of pack, the nutrition
declaration and the ingredients list – to identify the “better for
you” options.
• Inappropriate marketing and promotion of unhealthy
commercial foods for infant and young children should be
avoided as it can undermine exclusive and continued
breastfeeding. It can discourage caregivers from feeding their
children a home prepared and diverse diet and create
dependency on commercial products.
• Mass distribution of unhealthy foods for children should be
discouraged for targeted or blanket distribution by the
Government and partners.
• Foods which do not meet WHO recommendationsxiv for a
healthy diet may undermine local food use and recommended
dietary practices and contribute to an expansion of
consumption of unhealthy foods.
• Donations for unhealthy foods should not be sought or accepted
for targeted or blanket distribution during the emergency
response by the Government and partners.
• Such engagement carries the risk of the government and its
partners to be perceived as endorsing a specific brand or
products. Engagement with companies producing unhealthy
food may damage reputation of the host governments, donor
governments and communities. It may also appear to contradict
the efforts on prevention of overweight.
• Companies that manufacture BMS should continue to be
excluded from any in-kind donations, funding engagements or
co-branded partnerships.
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Delivering through the Health System in the context of COVID-19
In health facilities, infants born to
mothers with suspected, probable, or
confirmed COVID-19 should be fed
according to recommended infant
feeding guidelines, while following
necessary respiratory hygiene during
feedingxv.
Mothers and infants should be
provided with skilled breastfeeding
support if needed and enabled to
practice skin-to-skin contact, kangaroo
mother care and to remain together
and to practice rooming-in throughout
the day and night, especially
immediately after birth during
establishment of breastfeeding,
whether they or their infants have
suspected, probable, or confirmed
COVID-19.
In situations when severe illness in a
mother with COVID-19 or other health
complications, prevents her from
caring for her infant or prevents her
from continuing direct breastfeeding,
mothers should be encouraged and
supported to express milk, and safely
provide breastmilk to the infant, while
applying appropriate hygiene
measures.
Infant and young child feeding
counselling, basic psychosocial
support, and practical feeding support
should be provided to all pregnant
women and mothers with infants and
young children, whether they or their
infants and young children have
suspected, probable or confirmed
COVID-19.
• Establish safe breastfeeding protocolsxvi for infected mothers and
policies to avoid widespread distribution and donations of
breast- milk substitutes (BMS) while ensuring that infants under
6 months with no possibility to be breastfed are adequately
supported with infant formula.
• Mothers should be counselled/ advised to continue
breastfeeding should the infant or young child become sick with
suspected, probable, or confirmed COVID-19 or any other illness.
• As with all probable, confirmed or suspected COVID-19 cases,
symptomatic mothers who are breastfeeding or practicing skin-
to-skin contact or Kangaroo Mother Care (KMC) should practice
necessary respiratory hygiene (such as, wear a face mask),
including during feeding.
• If the mother has respiratory symptoms, it is recommended to
use of a face mask when near a child, if possible), perform hand
hygiene before and after contact with the child, and routinely
clean and disinfect surfaces with which the symptomatic mother
has been in contact.
• If the mother is expressing breast milk with a hand, manual or
electric breast pump, she should wash her hands before
expressing breastmilk or touching any pump or bottle parts and
ensure proper pump cleaning after each use.
• The expressed breastmilk should be fed to the child using a clean
cup and/or spoon, preferably by a person who has no signs or
symptoms of illness.
• If the mother is too unwell to breastfeed or express breastmilk
or donor milk is unavailable, an appropriate breastmilk
substitutexvii, informed by cultural context, acceptability to the
mother, and service availability should be provided.xviii
• The delivery of inter-personal and group counseling through
health facility and community platforms will be limited in the
context of COVID-19. Wherever counseling is being delivered
through health and community platforms, physical visits should
be minimize and use virtual channels should be encouraged
(such as phones, social media and others) to provide information
to families on breastfeeding and complementary feeding
behaviours at critical times, for example, when the mother and
infant are discharged from the health facility, during the
transitional phase from exclusive BF to initiate timely
complementary feeding.
• In the context of panic, lockdown and concern for family
members, this could be a highly stressful time for pregnant and
lactating mothers. Basic psychosocial support should be a key
component of counsellingxix.
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Delivering through the Water and Sanitation System in the context of COVID-19
Intensify the integration of messages
on safe hygiene practices for young
children using innovation
communication channels- digital,
broadcast and social media - as part of
nutrition service delivery through
Health, WASH and Social Protection
platforms.
Delivering through the Social Protection System in the context of COVID-19
Improve access to nutritious and
healthy food choices coupled with
nutrition counseling through Social
Protection programmes and services
(direct or indirect food assistance), for
infants and young children. This may
also include provision of nutritious
food options or vitamin and mineral
supplements to improve the quality of
young children’s diets.
When social protection services
include food supplementation or
distribution, avoid provision of
unhealthy foods as part of alternative
arrangements and avoid partnerships
with food and beverage companies
that produce unhealthy foods in
maintaining these services.
•In case of operational service delivery through health and other
platforms, ensure integration of recommended hygiene
practices (such as handwashing with soap and regular cleaning
and disinfecting of food preparation areas) into the counseling
and support.
• In the context of COVID-19, routine service delivery (inter-
personal counseling and group counseling) counseling through
facility, community and social protection platforms may not be
functional and virtual channels (such as digital and social media-
based applications) will have to be used for delivering key
messages on safe food preparation, feeding, storage as well as
importance of safe and palatable drinking water for their young
children.
• Ensure integration of harmonized messages on safe hygiene
into all relevant opportunities and multiple communication
channels through the health system to ensure its reach and
application.
• Provision of nutritious food options or vitamin and mineral
supplements should always be accompanied with appropriate
infant and young child feeding messages, counseling and
support.
• Pre-position essential nutrition commodities (micronutrient
powders, lipid-nutrient supplements, Vitamin A etc) in
anticipation of supply chain disruptions. Pre-positioning of
infant formula for infants less than six months who are not
breastfed also needs to be consideredxx.
• The provision of essential food assistance (e.g. direct provision
or price discounts) may be needed in the short term for
vulnerable populations to secure access to nutritious foods.
Such efforts would need to link with long term measures such
as supporting livelihoods in order to sustain healthy practices.
• Monitoring and tracking of service delivery is critical to ensure
reaching infant and young children who are most in need for
the services (such as malnourished children).
• Raise awareness to inform decisions of the government and
partners regarding the risks associated with accepting donated
supplies of unhealthy foods in emergencies and/or partnering
with companies that produce unhealthy foods.
• Organizations working on the emergency response at country
level may consider joining forces to issue tailored guidance to
countries on this issue, especially around ensuring the
nutritional quality of foods provided under alternative
approaches such as community-based provision, take-home
rations, home delivery or vouchers.
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 OUTSTANDING PROGRAMMATIC QUESTIONS TO BE ADDRESSED AS EVIDENCE EMERGES
• What is the feasibility of using digital technology platforms to provide individual counseling and support
to caregivers on infant and young child feeding when conducting inter-personal counseling sessions with
caregivers and group counseling sessions is no longer possible?
• What is the feasibility of promoting the use of home fortification products (such as multiple micronutrient
powders and lipid-based nutrient supplements) to improve the quality of children’s diets in the settings
where the access of such supplements is hindered through health system and pharmacies?
• What are the most appropriate rules of engagement with the private sector for the provision of nutritious
foods for young children in the context of this pandemic?

USEFUL GUIDANCE AND RESOURCES

• UNHCR/UNICEF/WFP/WHO. Infant and Young Child Feeding in the Context of the COVID-19 Pandemic,
Eastern, Central and Southern Africa. Released 26 March 2020
• Operational guidance on Infant feeding in emergencies: https://www.ennonline.net/attachments/3127/Ops-
G_English_04Mar2019_WEB.pdf
• UNICEF’s programming guidance on improving young children’s diets during the complementary
feeding period: https://mcusercontent.com/fb1d9aabd6c823bef179830e9/files/1c81003c-e36d-4788-90e1-
191610423755/Complementary_Feeding_Guidance_2020_portrait_ltr_web2.pdf
• WHO Guidance on clinical management of COVID-19: https://www.who.int/publications-detail/clinical-
management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
• WHO Interim guidance on home care for patients with COVID-19 presenting with mild symptoms and
management of their contacts: https://www.who.int/publications-detail/home-care-for-patients-with-
suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
• UNICEF Coronavirus disease (COVID-19) – What parents should know: www.unicef.org/stories/novel-
coronavirus-outbreak-what-parentsshould-know
• UNICEF, ILO & UN Women, 2020. Family-friendly policies and other good workplace policies in the context of
COVID-19: Key steps employers can take https://www.unicef.org/documents/family-friendly-policies-and-other-
good-workplace-practices-context-covid-19-key-steps
• WHO, 2020. Home care for patients with COVID-19 presenting with mild symptoms and management of their
contacts: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-
(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
• GTAM, 2020. COVID-19: Summary of Guidance available for Nutrition in Emergencies Practitioners:
http://nutritioncluster.net/resources/gtam-covid19-nutrition-technical-brief-20200313-final/

ENDNOTES

i Breastfeeding should be initiated within 1 hour. Exclusively breastfeeding should be continued for the first 6 with timely introduction
of age-appropriate, adequate, safe and properly fed complementary foods at age 6 months, while continuing breastfeeding for up to 2
years of age or beyond.
ii WHO recommends that all laboratory confirmed cases be isolated and cared for in a health care facility. WHO recommends that all

persons with suspected COVID-19 who have severe acute respiratory infection be triaged at the first point of contact with the health care
system and that emergency treatment should be started based on disease severity. In situations where isolation in a health care facility
of all cases is not possible, WHO emphasizes the prioritization of those with highest probability of poor outcomes. If all mild cases cannot
be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as
repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus
are negative.
iii
Caring for mothers and infants with COVID-19: IPC and breastfeeding. Clinical Management of severe acute respiratory
infection (SARI) when COVID-19 disease is suspected. WHO Interim Guidance. (13 March 2020).
https://www.who.int/csr/disease/coronavirus_infections/case-management-ipc/en/
iv In settings where diarrhea, respiratory infections and infectious morbidity are common in infants, any possible risk of transmission of

COVID-19 through breastfeeding (not reported to date) is outweighed by the known risks associated with replacement feeding.
v WHO Essential newborn care and breastfeeding (https://apps.who.int/iris/bitstream/handle/10665/107481/e79227.pdf)
vi
For more information on what, when and how to feed young children during the complementary feeding period. Refer to UNICEF
Programming Guidance on improving young children’s diets during the complementary feeding period. New York: United Nations
8
Children’s Fund, 2020. https://mcusercontent.com/fb1d9aabd6c823bef179830e9/files/1c81003c-e36d-4788-90e1-
191610423755/Complementary_Feeding_Guidance_2020_portrait_ltr_web2.pdf
vii Under development: UNICEF IYCF web page which will be out in next few days
viii
https://apps.who.int/iris/bitstream/handle/10665/43546/9789241594639_eng.pdf;jsessionid=0AE37B6A521BC120E2F224E5A9E1FB
75?sequence=1
ix For more information on specific guidance on hygiene programming in the context of COVID-19. Refer to UNICEF’s Hygiene

Programming Guidance Note https://unicef.sharepoint.com/:b:/r/sites/EMOPS-

2019nCoV/DocumentLibrary1/WASH%20COVID19/COVID19%20Hygiene%20Programming%20Guidance_March10.pdf?csf=1&e=PGsu1
0
x Access UNICEF’s First foods video series at UNICEF website https://www.unicef.org/nutrition/102823_The%20video%20series.html

and at Global Health media’s website at https://globalhealthmedia.org/videos/

xi Videos on breastfeeding: while the videos are not specific to the COVID-19 context, they provide useful information and tips on how

to support breastfeeding including hand expression of milk. https://globalhealthmedia.org/videos/breastfeeding/

xii
For more details, refer to Operational Guidance on infant feeding in emergencies. (2017)
https://www.ennonline.net/operationalguidance-v3-2017
xiii
Examples of unhealthy foods include, but are not limited to, candy, potato or corn chips, soft drinks such as soda or
chocolate-flavoured milk, instant noodles, biscuits/cookies/wafers/cakes, pizza, pies or burgers and other fast foods
xiv
For more details on WHO’s recommendation on healthy diet, refer https://www.who.int/news-room/fact-sheets/detail/healthy-diet
xv In settings where diarrhea, respiratory infections and infectious morbidity are common in infants, any possible risk of transmission of
COVID-19 through breastfeeding (not reported to date) is outweighed by the known risks associated with replacement feeding.
xvi
Mothers and infants should be enabled to remain together and practice skin-to-skin contact, kangaroo mother care and
to remain together and to practice rooming-in throughout the day and night, whether they or their infants have suspected, probable or
confirmed COVID-19 virus infection. See also WHO Guideline: protection, promoting and supporting breastfeeding in facilities providing
maternity and newborn services https://apps.who.int/iris/bitstream/handle/10665/259386/9789241550086-eng.pdf
xvii Where breastmilk is not accessible, appropriate breastmilk substitutes include: Ready to Use Infant Formula if the infant is <6

months of age, and ultra-heat treated (UHT) milk and complementary feeding if the infant / baby is 6-23 months of age.
xviii There should be no promotion of breastmilk substitutes, donation of feeding bottles and teats, pacifiers or dummies or donations of

breastmilk substitutes in any part of facilities providing maternity and newborn services, or by any of the staff. Health facilities and their
staff should teach mothers/caregivers how to safely prepare milk and how to give milk using a cup with a wide mouth or a cup and
spoon. Health facilities and staff should not give feeding bottles and teats or other products within the scope of the International Code
of Marketing of Breast-milk Substitutes and its subsequent related WHA resolutions, to breastfeeding infants. Please note wet nursing
is not recommended in contexts of high HIV prevalence and donor milk should only be considered if appropriate screening and
pasteurization services are included.
xix
Important to pay attention to caregiver physical and mental health and address their needs for support in every health service
contact. See Operationalizing the nurturing care for early childhood development https://nurturing-care.org/wp-
content/uploads/2019/07/Operationalizing-NC.pdf
xx UNICEF Guidance on the provision and use of breastmilk substitutes in humanitarian settings. New York: United Nations Children’s

Fund, 2018. http://www.unicefinemergencies.com/downloads/eresource/docs/2.3%20Nutrition/Unicef_BMS_R05.1_Interactive.pdf